Article by Bowel Cancer UK
Early detection is key to successfully treating bowel cancer. I have several friends and family members who have been diagnosed with bowel cancer- they have all been successfully treated following early diagnosis. The over 50s are most affected. I asked Bowel Cancer UK to explain the symptoms and treatments.
1. What is the bowel?
The bowel (also known as the large intestine) is divided into the small bowel (small intestine) and the large bowel (colon and rectum).
Nearly all bowel cancers develop in the large bowel. Two-thirds of these are in the colon and one-third in the rectum. Bowel cancer is also referred to as colorectal, colon or rectal cancer.
Cancer of the small bowel is rare with only just over 700 people diagnosed in the UK each year.
The bowel is part of our digestive system. Food passes from the stomach to the small bowel. After the small bowel takes nutrients into the body, any undigested food passes through the large bowel, where water is removed from the waste matter. This waste matter is held in the rectum (back passage) until it leaves the body as bowel motions (also known as stools or faeces).
Cancer occurs when cells in your bowel multiply out of control. These cells can invade surrounding tissue and spread to other parts of the body.
Most bowel cancers develop from polyps which are usually non-cancerous and, once detected, can be removed easily if caught early enough.
2. Does Bowel Cancer affect both sexes equally?
Nearly 40,000 men and women are diagnosed with bowel cancer in the UK every year. In 2008 (the latest statistics available), 22,097 men were affected and 17,894 women.
3. How prevalent is bowel cancer in the over 50s?
95% of all diagnoses are in people over the age of 50.
4. Are there any predisposing factors which place people in high risk group?
Although the exact cause of bowel cancer is unknown, there are certain factors that may increase your risk.
Gender and age
Bowel cancer affects both men and women. In the UK, around 95% of cases occur in people over the age of 50.
People with a first degree relative (such as mother, father, brother, sister, child) under 45. Or with two or more first degree relatives with bowel cancer may be considered for further testing and may have a small increased risk of developing the disease. You should discuss this with your GP if you are concerned about this.
Diet and lifestyle
An inactive lifestyle and a poor diet that is high in red and processed meat and low in fresh fruit and vegetables may increase the risk of bowel cancer. Smoking and drinking more than the recommended amounts of alcohol may also increase your risk.
People with diabetes or who have an inflammatory bowel condition, such as Crohn’s disease or ulcerative colitis, or who have had previous polyps removed, may also be at an increased risk.
5. Are you more likely to have bowel cancer if someone in your family has it?
People with a first degree relative (such as mother, father, brother, sister, child) under 45 or with two or more first degree relatives with bowel cancer may have a small increased risk and might be put on a surveillance programme.
6. What are the symptoms of bowel cancer people should be alerted by?
The symptoms of bowel cancer can be:
• A change in your normal bowel habit lasting four weeks or more
• Bleeding from the bottom and/or blood in your stools (poo)
• Unexplained extreme tiredness and/or unexplained weight loss
• A pain or lump in your abdomen (tummy)
You might experience one, some, all of the above or no symptoms at all. Remember most symptoms will not be bowel cancer.
7. How soon should you go to the doctor if you experience these symptoms?
If you do experience any of these symptoms and are concerned you should visit your doctor as soon as possible. Bowel cancer is very treatable if diagnosed early.
8. How is the diagnosis made?
Usually you begin by seeing your GP who will discuss your symptoms with you. You will be asked about your bowel habits or pattern. It is important to describe what is normal or abnormal for you. If you are aware of them, you should also mention any cases of the disease in your family. Depending upon your symptoms, the doctor may want to feel your abdomen and examine your back passage – a digital rectal examination, if you are comfortable for them to do so. During this procedure, the doctor places a gloved finger into the back passage to feel for any lumps or swellings. This may be uncomfortable but it is not painful. You may be asked to take a sample of your stool (poo) to the surgery so that it can be tested for blood, as both polyps (which are small growths within the bowel) which could turn cancerous and tumours often bleed. You may also have a blood test to check for anaemia. If your GP thinks that your symptoms could be caused by cancer you will be referred to a hospital specialist. You should be seen within two weeks and will normally be sent for further tests such as a colonoscopy (which examines all of the rectum and colon) or a flexible sigmoidoscopy (which examines the rectum and lower part of the colon).
9. Is a colonoscopy painful?
In the examination room you will be made comfortable on a couch, the nurse will stay with you throughout the test. You may be given a light sedation which helps you to relax during the procedure. The doctor or nurse will gently pass a long flexible tube that has a light and camera on the end into your back passage then into the bowel. Air will be passed through it to distend the bowel to give a clearer view of the lining. This may give you some wind-like pains but they will not last long.
After the test you will be left in the unit to rest for at least thirty minutes. You may feel a little bloated with wind pains but these usually settle very quickly. Most people are ready to go home after a couple of hours but it is essential that someone comes to pick you up and, if you have been sedated, that you do not drive for several hours.
10. What does the treatment involve (surgery, chemotherapy, radiotherapy)?
The treatments for colon or rectal cancer are different. You will have many options to consider. Your specialist nurse or consultant will discuss these with you. Treatments are decided upon within the context of the multidisciplinary team (MDT) where all members of the team managing the patient’s treatment are involved.
If you are diagnosed with cancer that is situated in the colon (the large bowel is made up of the colon and the rectum), then the most common form of treatment is surgery. The colorectal (bowel) surgeon will discuss the type of surgery needed. This may be either open or keyhole surgery depending upon your particular case and the surgical expertise available within the hospital treating you. . In some instances surgery might not be possible and you may be offered chemotherapy first, but this is far less common.
Often after surgery, unless the cancer is detected in the very early stages, chemotherapy will be recommended. The oncologist, a clinician specialising in cancer treatments and care, will discuss the treatment plan with you.
Treating cancer in the rectum usually involves a short course of radiotherapy and chemotherapy, known as chemoradiation, prior to surgery and it may also be followed by further chemotherapy afterwards as well.
11. What is the success rate?
Bowel cancer is very treatable if diagnosed early with 90% of patients surviving for more than 5 years. However, currently only 9% of patients in the UK are diagnosed at the very earliest stage of the disease. Five year survival rates drop dramatically for patients diagnosed at later stages.
12. Will you be able to lead a normal life afterwards?
Many people do lead a normal life after treatment, but of course it does depend on what you have had done and how early your cancer was detected. Bowel cancer and its treatments can cause physical changes in your body. These changes may be difficult to cope with and may affect the way you feel about yourself. You may also find that you need to change your diet to help your bowel work as normally as possible and may also need to work out how you manage practically as well, particularly straight after treatment. You could also call Bowel Cancer UK’s Freephone Advisory Service on 0800 8 40 35 40 and speak to one of their specialist nurses who can help and support you through your treatment and your recovery.
13. Is it a cancer which can spread rapidly if not treated?
Yes, bowel cancer can spread and in some people can spread quite quickly although many bowel cancers take years to develop. It normally spreads first to the liver and then the lungs (these additional secondary tumours are called metastases). Other sites of spread are locally within the pelvis and abdomen, close to the original tumour in the bowel, and to the bones. Very occasionally it can also spread to the brain. This is why early diagnosis is so essential.
14. Is there an argument to suggest that after a certain age everyone should have a colonoscopy at regular intervals (like mammograms)?
There are bowel cancer screening programmes available throughout the UK. The age range differs in each country. In England you will be invited for screening if you are aged between 60-69, although this is currently being extended to 74. In Wales and parts of Northern Ireland (where the programme is not yet fully rolled out) you will be invited for screening if you are between 60 and 69. In Scotland it is if you are aged between 50 and 74. To be invited to take part you must be registered with a GP. The kit tests for faecal occult blood (blood hidden in poo). It does not diagnose cancer. If blood is found in the sample you will be invited for more tests and this will most likely be a colonoscopy.
People with a first degree relative (such as mother, father, brother, sister, child) under 45 or with two or more first degree relatives with bowel cancer may be put on a surveillance programme which might involve more regular screening, usually a colonoscopy.
15. Can people take preventive measures?
A few simple lifestyle changes can help you to reduce the risk of developing bowel cancer.
• Know the symptoms of bowel cancer.
• Get to know your bowel pattern, so that you know what’s normal for you.
• Keep to a healthy weight through regular exercise.
• Avoid processed meat as much as possible and limit red meat consumption
• Eat a diet high in fibre, including at least five portions of fresh fruit and vegetables every day.
• Do not drink too much alcohol. Men should not exceed 3-4 units per day. Women should not exceed 2-3 units per day.
• Don’t smoke.
• Be aware of your bowel cancer family history. You may be eligible for screening.
For further information and support contact http://www.bowelcanceruk.org.uk/